Med/Surg 1 – Fluid and Electrolytes

Causes of HYPOcalcemia
Hypoparathyroidism, infusion of citrated blood, acute pancreatitis, hyperphosphatemia, inadequate dietary intake of Vit D, or continuous or long-term use of laxatives

Mg+ deficiency, medullary thyroid carcinoma, low serum album levels, or alkalosis.

Use of aminoglycosides, caffeine, calcitonin, corticosteriods, loop diauretics, nicotine, phosphates. radiographic contrast media, or aluminum-containing antacids.

Signs and Symptoms of HYPOcalcemia

Tingling around the mouth and in the fingertips and feet, numbness, painful muscle spasms, and tetany

Positive Trousseau’s (contracture of the joints) and Chvostek’s Signs (facial)

Bronchospasm, Laryngospasm, and airway obstruction.


Changes in Cardiac conduction

Depression, impaired memory, confusion, and hallucinations

Dry or scaling skins, brittle nails, dry hair and cataracts

Skeletal fractures resulting from osteoporosis

Nursing Care of Patients with HYPOcalcemia
Identify patients at risk for HYPOcalcemia
Assess the patient for signs and symptoms of HYPOcalcemia, especially changes in in cardiovascular and neurologic status and in vital signs.
Administer IV Calcium as prescribed
Administer a phosphate-binding antacid
Review the procedure of eliciting a Trouseau’s and Chovstek’s signs
Take seizure or or emergency precautions, as needed
Encourage a patient with Osteoporosis to perform weight-bearing exercise regularly
Encourage the patient to increase his intake of foods that are rich in calcium and vit D
Teach the patient and his family how to prevent, recognize, and treat hypocalcemia

Cause of HYPERcalcemia
Malignant neoplasms, metastatic bone cancer, hyperparathyroidism, immobilization and loss of bone mineral or thiazide diuretic use

High Ca+ Intake

Hyper or Hypothyroidism

Signs and Symptoms of HYPERcalcemia

Muscle weakness and lack of coordination

Anorexia, constipation, abdominal pain, nausea, vomiting, peptic
ulcers, and abdominal distentention

Confusion, impaired memory, slurred speech, and coma

Polyuria and renal colic

Cardiac arrest

Nursing Care of Patients with HYPERcalcemia
Identify patients at risk for HYPERcalcemia
If the patient is receive Digoxin, assess him for signs of digoxin toxicity
Assess the patient for signs and symptoms of HYPERcalcemia
Encourage ambulation
Move the patient careful to prevent fractures
Take safety or seizure precautions as needed
Have emergency equipment available
Administer phosphate to inhibit GI absorption or Ca
Administer a loop diuretic to promote Ca excretion
Force fluids with high acid-ash concentration, such as cranberry juice, to dilute and absorb calcium
Reduce dietary calcium
Teach the patient and his family how to prevent, recognize and treat HYPERcalcemia, especially if the patient has metastatic cancer

Causes of HYPOkalemia
GI losses from diarrhea, laxative abuse, prolonged gastric suctioning, prolonged vomiting, ileostomy or colostomy.
Renal losses related to diuretic use, renal tubular acidosis, renal stenosis or hyperaldosteronism
Use of certain antibiotics, including PCN G, Carbenicillin or Amphotericin B
Steroid therapy
Severe perspiration
Hyperalimentation, alkalosis, or excessive blood insulin levels
Poor nutrition

Signs and Symptoms of HYPOkalemia
Fatigue, muscle weakness, and paresthesia
Prolonged cardiac repolarization, decreased strength of myocardial contraction, orthostatic hypotension, reduced sensitivity to Digoxin, increased resistance to antiarrythmics and cardiac arrest
Flat ST segment and wave on EKG
Decreased bowel motility
Suppressed insulin release and aldosterone secretion
Inability to concentrate urine and increased renal Ph excretion
Respiratory muscle weakness
Metabolic alkalosis, low urine osmolality, slightly elevation glucose level, and myoglubinuria

Nursing Care of Patients with HYPOkalemia
Identify patients at risk for HYPOkalemia
Assess patient’s risk for lack of potassium
Assess for signs and symptoms of HYPOkalemia
Administer a potassium replacement as prescribed
Encourage intake of high potassium foods (bananas, dried fruit and orange juice)
Monitor for complications
Have emergency equipment available for cardiopulmonary resuscitation and cardiac defibrillation
Teach the patient and his family to prevent, recognize, and treat HYPOkalemia

Causes of HYPERkalemia
Decreased renal excretion related to oliguric renal failure, potassium sparing diuretic use, or adrenal steroid deficiency
High potassium intake related to the improper use of oral supplements, excessive use of salt substitutes, or rapid infusion of potassium solutions
Acidosis, tissue damage, or malignant cell lysis after chemotherapy

Signs and Symptoms of HYPERkalemia
Cardiac conduction disturbances, ventricular arrhythmias, prolonged depolarization, decreased strength of contraction and cardiac arrest
Tall, tented T wave, prolonged QRS complex, and PR interval on EKG
Muscle weakness and paralysis
Nausea, vomiting, diarrhea, intestinal colic, uremic enteritis, decreased bowel sounds, abdominal distention and paralytic ileus

Nursing Care of the Patient with HYPERkalemia
Identify the patient at risk
Assess the patient’s diet for excess use of salt substitutes
Assess the patient for signs and symptom’s of HYPERkalemia
Asses ABG’s for metabolic alkalosis
Take precautions when drawing blood samples. A falsely elevated K+ level can result from hemolysis (breakdown of RBC’s) or prolonged tourniquet application
Have emergency equipment available
Administer calcium gluconate to decrease myocardial irritability
Administer insuling and IV glucose to move potassium back into cells. Carefully monitor serum glucose levels
Administer SPS (Kayexalate) with 70% Sorbitol to exchange Na+ for K+ ions in the intestines
Perform hemodialysis or peritoneal dialysis to remove excess potassium
Teach the patient and his familt to prevent, recognize and treat HYPERkalemia

Causes of HYPOmagnesemia
Alcoholism, protein-calorie malnutrition, I.V. Therapy without Mg replacement, gastric suctioning, malabsorption syndromes, laxative abuse, bulimia, anorexia, intestinal bypass for obesity, diarrhea or colonic neoplasms
HYPERaldosteronism or renal disease that impairs Mg reabsorption
Use of osmotic diuretics or antibiotics such as Gentamycin
Overdose of Vit D or calcium, burns, pancreatitis, sepsis, hypthermia, exchange, transfusion, hyperalimentation, or DKA

Signs and Symptoms of HYPOmagnesemia
Muscle weakness, tremors, tetany, and clonic or focal seizures
Laryngeal stridor
Decreased blood pressure, ventricular fibrilation, tachyarrhythmias and increased susceptibility to digoxin toxicity
Apathy, depression, agitation, confusion, delirium and hallucinations
Nausea, vomiting, and anorexia
Decreased Ca level
Positive Chvostek’s and Trousseau’s signs

Nursing Care of the Patient with HYPOmagnesemia
Identify patients at risk for HYPOmagnesemia
Assess the patient for signs and symptoms of HYPOmagnesemia
Administer I.V. Mg as prescribed
Encourage the patient to each Mg rich foods
If the patient is confused or agitated, take safety precautions
Take seizure precautions as needed
Have emergency equipment available Calcium Gluconate is used to treat tetany
Teach the patient and his family how to prevent, recognize and treat HYPOmagnesemia

Causes of HYPERmagnesemia
Renal failure, excessive antacid use (especially in a patient with renal failure), adrenal insufficiency, or diuretic use
Excessive Mg replacement or excessive use of MOM or other Mg-containing laxative

Signs and Symptoms of HYPERmagnesemia
Peripheral vasodilation with decreased blood pressure, facial flushing and sensations of warmth and thirst
Lethargy or drowsiness, apnea, and coma
Loss of deep tendon reflexes, paresis and paralysis
Cardiac arrest

Nursing Care of Patient’s with HYPERmagnesemia
Identify patients at risk for hypermagnesemia
Review all medications for a patient with renal failure
Assess the patient for signs and symptoms of HYPERmagnesemia
Assess reflexes; if absent, notify MD
Administer calcium gluconate
Have emergency equipment available
Prepare the patient for hemodialysis if prescribed
IF the patient is taking an antacid, a laxative, or another drug that contains Mg, instruct him to stop
Teach the patient and his family to prevent, recognize and treat HYPERmagnesemia

Causes of dilutional HYPOnatremia
Excessive water gain caused by inappropriate administration of IV solutions, syndrome of inappropriate antidiuretic hormone (SIADH), Oxytocin use for labor induction, water intoxication, heart failure, renal failure, or cirrhosis

Signs and Symptoms of dilutional HYPOnatremia
Weight gain
Muscle spasms, convulsions

Nursing care of the patient with dilutional HYPOnatremia
Identify patients at risk for HYPOnatremia
Assess I&O
Assess the patient for signs and symptoms for HYPOnatremia
If the patient has dilutional HYPOnatremia, administer isotonic IV fluids
Teach the patient and his family to prevent, recognize and treat dilutional HYPOnatremia

Causes of True HYPOnatremia
Excessive Na loss d/t GI losses, excessive sweating, diuretic use, adrenal insufficiency, burns, lithium use, starvation

Signs and Symptoms of true HYPOnatremia
Orthostatic hypotension
Dry mucous membranes
Weight loss
Nausea, vomiting

Nursing Care of the patient with true HYPOnatremia
If the patient is receiving Li, teach him how to prevent alterations in his sodium levels
If the patient has adrenal insufficiency, teach him how to prevent HYPOnatremia
Teach the patient how to prevent, recognize and prevent HYPOnatremia

Causes of HYPERnatremia
Sodium gain that exceeds water gain related to salt intoxication (resulting from Sodium Bicarb use in cardiac arrest), HYPERaldosteronism or use of diuretics, vasopressin, corticosteroids, or some antihypertensives
Water loss that exceedssodium loss related to profuse sweating, diarrhea, polyuria, resulting from diabetes insipidus or diabetes mellitus, high-protein tube feedings, inadequate water intake, or insensible water loss

Signs and Symptoms of HYPERnatremia
Thirst; rough, dry tongue, dry sticky mucous membranes; flushed skin, oliguria; and low-grade fever that returns to normal when sodium levels return to normal.
Restlessness, disorientation, hallucinations, lethargy, seizures, and coma
Muscle weakness and irritability
Serum osmolality above 295 and urine specific gravity above 1.015

Nursing Care of Patients with HYPERnatremia
Identify patients at risk for HYPERnatremia
Assess the patient for fluids losses and gains
Assess the patient for signs and symptoms for HYPERnatremia
Consult with the nutritionist to determine the amount of free water needed with tube feedings
Encourage the patient to increase his fluid intake but decrease sodium intake
If the patient is agitated or is experiencing seizure, take safety precautions
Teach the patient and his family to prevent, recognize and treat HYPERnatremia

Causes of HYPOphosphatemia
Glucose administration or insulin release, nutritional recovery syndrome, overzealous feeding with simple carbohydrates, respiratory alkalosis, alcohol withdrawl, DKA, starvation
Malabsorption syndromes, diarrhea, vomiting, aldosteronism, diuretic therapy, or use of drugs that bind with phosphate such as Aluminum Hydroxide or MOM

Signs and Symptoms of HYPOphosphatemia
Irritability, apprehension, confusion, decreased LOC, seizures, and coma
Weakness, numbness, and paresthesia
Congestive cardiomyopathy
Respiratory muscle weakness
Hemolytic anemia
Impaired granulocyte function, elevated Cr kinase level, HYPERglycemia, and metabolic acidosis

Nursing Care of Patients with HYPOphosphatemia
Identify patients at risk for HYPOphosphatemia
Assess the patient for sugns and symptoms of HYPOphosphatemia, especially neuorlogic and hematologic ones
Administer phosphate supplements as prescribed
Note calcium and phosphorus levels because they have an inverse relationship
Gradually introduce hyperalimentation as prescribed
Teach the patient and his family how to prevent, recognize and treat HYPOphosphatemia

Causes of HYPERphosphatemia
Renal disease
Hypoparathyroidism or hyperthyroidism
Excessive VIt D Intake
Muscle necrosis, excessive phosphate intake, or chemotherapy

Signs and Symptoms of HYPERphosphatemia
Soft-tissue calcification (chronic HYPERphosphatemia)
HYPOcalcemia, possible tetany
Increased RBC

Nursing Care for Patients with HYPERphosphatemia
Identify patient at risk for HYPERphosphatemia
Assess the patient for signs and symptoms of HYPERphosphatemia and HYPOcalcemia, including tetany and muscle twitching
Advise the patient to avoid foods and medications that contain phosphorus.
Administer phosphorus-binding antacids
Prepare the patient for possible dialysis
Teach the patient and his family how to prevent, recognize and treat HYPERphosphatemia

Signs and Symptoms of Dehydration
Dizziness, fatigue,

Sodium 135 – 145 mEq/L; found in bacon, ham, processed cheese, table salt Potassium 3.5 – 5.0 mEq/L; found in avocado, carrot, potato, tomato, spinach, beef, cod, pork, banana, apricot, cantaloupe, milk, OJ, apricot nectar WE WILL WRITE A CUSTOM …

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Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate? Limit sodium and water intake. The nurse is instructing a patient with recurrent hyperkalemia about following a potassium-restricted diet. Which of the following …

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